What is the role of neuropsychological testing in the workup of postconcussion syndrome (PCS)?

Updated: Sep 24, 2018
  • Author: Eric L Legome, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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Neuropsychological testing rarely is performed in the acute setting, although it may have some value in predicting the development of symptoms. A series of standardized tests and questionnaires are used to measure attention, language, memory, emotional functioning, and other neurobehavioral parameters.

The Rivermead Postconcussion Symptoms Questionnaire is used to quantify postconcussion syndrome symptoms.

Neuropsychological assessments may be used. These include the Wechsler Adult Intelligence Scale and specific subtests (digit span and vocabulary), Trail Making Test, complex figure drawings (eg, Rey Osterreith), copy trials and memory trials, category tests, controlled oral word association (Hopkins Verbal Learning Test), Wisconsin Card Sorting Test, and the Paced Auditory Serial Addition Task.

The objective personality measure, Minnesota Multiphasic Personality Inventory, Second Edition (MMPI2), may be used.

The Hospital Anxiety and Depression Scale, Impact of Even Scale, Galveston Orientation and Amnesia Test, and assessments of posttraumatic amnesia are used together as prognostic screening instruments for predicting PCS persistence.

In an exploratory factor and confirmatory factor analysis of a 19-item Postconcussion Symptom Scale broken up into 3 factors (neurocognitive, somatic, emotional), patients seen more than 14 days after the concussion injury had worse factor 3 (emotional) scores than those seen less than 14 days after injury. Females and patients with anxiety disorders had significantly worse (higher) scores on all 3 factors. [35]

Sport Concussion Assessment Tool version 3 (SCAT-3) is one of the most widely researched concussion assessment tools in athletes. The presence and frequency of posttraumatic headache are associated with the SCAT-3 symptom severity score, which is an important predictor of post-concussion recovery. [36, 37, 38, 39, 40]

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